The nurse notes that the client has a prosthetic eye; however, the medical record does not specify which eye is prosthesis and the client is unconscious. Which method should the nurse use to identify the prosthetic eye?
1. Compare the eye color.
2. Check reaction to light.
3. Test for the blink reflex.
4. Try to remove each eye.
2
2. The nurse manually retracts the client's eyelids and uses a flashlight to evaluate the pupil's reaction to light to determine which eye is prosthetic because the prosthetic eye does not react to light.
1. The prosthetic eye should match the color of the client's eye.
3. To test the blink reflex, the nurse takes a wisp of cotton and brushes it across the client's cornea. This test can cause client discomfort and family members can become distressed when witnessing the introduction of a foreign object in the client's eye.
4. The nurse avoids attempting to remove each eye because trying to remove the client's eye can cause discomfort.
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